Reference no: EM133553697

Case Study: Mr. John Roberts a 59-year-old Caucasian man is newly admitted to the inpatient medical unit with a diagnosis of end stage metastatic lung cancer for end of life care. He was initially diagnosed a year ago, but treatment is no longer able to control the growth of malignant tumors that has spread to his brain, liver and spine and he was placed on Hospice Services six months ago. He has a past medical history of hypertension, anxiety, and was a former 20-pack per year cigarette smoker. He is currently a retired police officer who has been living at home with his wife of 30 years and they have no children. His current prescriptions include: Duragesic patch 25 micrograms transdermal applied every 48 hours, lorazepam intensol (Ativan) 0.5 mg (2.5 ml) sublingual every 4 hours prn restlessness or anxiety, morphine sulfate solution (10 mg per 5 ml) 2 mg (2 mg per 1 ml) sublingual every 2 hours prn pain, CMO (Comfort Measures Only), and indwelling Foley catheter and oxygen 2 liters via nasal cannula to promote comfort.

At change of shift the night nurse reports that Mr. Roberts' Foley catheter has only drained 25 ml of dark-colored urine in the last 24 hours. As the primary nurse assigned to care for Mr. Roberts you obtain his vital signs which are BP 80/40, HR 46, RR 26 and shallow. Mr. Roberts is moaning and restless and trying to climb over the side-rail of the bed calling for his mother. His wife is at the bedside and asking, "is he going to die now? I am not ready for him to die. He seems to be in a lot of pain. He is moaning a lot more." His wife states at times he is "not with it and appears confused. Is this normal?" She states she could not take care of him at home "it was too much for me." What is your initial assessment of Mr. Roberts?

Questions:

1.What would be some physical, psychological, social, and spiritual needs assessment?

2.What would be some of the medications Mr. Roberts is taking? Include indications, therapeutic and pharmaceutical class, generic/brand name, interactions and side effects?

3.What would be two priority nursing diagnoses that would be appropriate for Mr. Roberts.

4.What interventions should be considered for Mr. Roberts using evidence-based guidelines?

5.How would you respond therapeutically to Mrs. Roberts questions?